Staple feeding and forming apparatus

ABSTRACT

Disclosed is a surgical stapling apparatus and method of use that includes a cartridge assembly which is capable of being reloaded during a surgical procedure without being removed from the surgical site. This allows a surgeon to continue a surgical operation without withdrawing or removing the surgical stapler for reloading and thus reduces the length of the surgery while allowing the physician to concentrate solely on the surgical procedure rather than dividing attention between the surgical procedure and reloading of the surgical stapler. The surgical stapling apparatus includes an elongate member having a plurality of fasteners arranged in a plurality of longitudinally extending rows which is longitudinally translatable through the cartridge to position the plurality of fasteners relative to a plurality of retention slots extending through an upper surface of the cartridge.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/762,511, filed Feb. 8, 2013, which is a continuation of U.S. patentapplication Ser. No. 13/281,888, filed Oct. 26, 2011, now U.S. Pat. No.8,418,908, the entire contents of which are incorporated by referenceherein.

BACKGROUND

Technical Field

The present disclosure relates to surgical staplers. More particularly,the present disclosure relates to a surgical stapling apparatus capableof being reloaded during a surgical procedure without being removed fromthe surgical site.

Background of the Related Art

Surgical devices for first grasping or clamping tissue between opposingjaw structure and then stapling the tissue with surgical fasteners arewell known in the art. In some instruments a knife is provided to cutthe tissue which has been stapled by the fasteners. Instruments for thispurpose typically include two elongated members, one of which carries astaple cartridge and the other of which includes an anvil. The staplecartridge houses a plurality of staples arranged in at least two lateralrows. The anvil defines a surface for forming the staple legs as thestaples are driven from the staple cartridge. In certain devices, thestapling operation is effected by cam bars that travel longitudinallythrough the staple cartridge. A knife may travel between the staple rowsto longitudinally cut and/or open the stapled tissue between the rows ofstaples.

Often all or part of the stapling assembly of the surgical device islocated on a loading unit that is operably connected to a handleassembly. While the handle assembly is configured for multiple uses, theloading unit can be configured for a single use. After the single use isexhausted, the loading unit is removed from the handle assembly andproperly disposed.

SUMMARY

Disclosed is a surgical stapling apparatus that includes a loading unitwhich is capable of being reloaded during a surgical procedure withoutbeing removed from the surgical site. This allows a surgeon to continuea surgical operation without withdrawing or removing the surgicalstapler for reloading and thus reduces the length of the surgery whileallowing the surgeon to concentrate solely on the surgical procedurerather than dividing attention between the surgical procedure and eitherreloading or replacing the surgical stapler.

An end effector for a surgical stapling apparatus is disclosed includinga housing defining a plurality of passageways and a lumen extendinglongitudinally therethrough. The end effector includes a cartridge whichextends from the housing having a channel extending longitudinallytherethrough. An upper surface of the channel includes a plurality ofretention slots extending therethrough for the reception of surgicalfasteners. The end effector also includes an elongate member having aplurality of fasteners arranged in a plurality of longitudinallyextending rows where the elongate member is longitudinally translatablethrough the housing and the cartridge. The elongate member may be madefrom a flexible material. A plurality of pushers is disposed within thecartridge and are operatively associated with the plurality of retentionslots and adapted to support the plurality of fasteners. The endeffector also includes a drive member which is movable through thecartridge and adapted to engage the plurality of pushers to urge theplurality of fasteners through the plurality of retention slots. Thedrive member may include an actuating member extending proximallytherefrom which is adapted to move the drive member through thecartridge.

Each of the plurality of pushers may include a post and the drive membermay include a slot where the post of each of the plurality of pushers isadapted to engage the slot of the drive member upon actuation of thedrive member. Each of the plurality of pushers may include a guidegroove and each of the plurality of fasteners may include acorresponding guide portion where the guide portion is adapted to engagethe guide groove to guide the fastener when the pusher urges thefastener through one of the plurality of retention slots.

The housing includes an upper housing and a lower housing with the lumenbeing defined between the upper and lower housings. The passageways ofthe housing extend from the lumen and are adapted to guide the fastenersthrough the housing.

The cartridge includes a plurality of grooved channels formed on anunderside of the upper surface and aligned with the passageways of thehousing. The plurality of grooved channels is laterally aligned with theplurality of retention slots of the upper surface. The plurality ofretention slots may include guide surfaces which are adapted for guidingthe plurality of surgical fasteners into the plurality of retentionslots.

The elongate member defines a plurality of openings arranged in aplurality of longitudinally extending rows where each opening is adaptedto receive a fastener and each opening may include perforations wherethe openings are adapted to tear along the perforations. Each openingmay include a pair of holes and a slit and each fastener may include abackspan and a pair of legs extending from the backspan. The backspan ofeach fastener may be disposed on a first side of the elongate member andthe pair of legs of each fastener may extend through the elongate memberto a second side of the elongate member.

A surgical stapling apparatus is disclosed including an actuatorassembly, a handle supported by the actuator assembly and including anactuation mechanism, an elongated body extending from the actuatorassembly and an end effector at the distal end of the elongated body.The end effector includes a housing defining a plurality of passagewaysand a lumen extending longitudinally therethrough. A cartridge extendsfrom the housing and includes a channel extending longitudinallytherethrough. The cartridge includes an upper surface with a pluralityof retention slots extending therethrough for the reception of surgicalfasteners. An elongate member including a plurality of fastenersarranged in a plurality of longitudinally extending rows islongitudinally translatable through the housing and the cartridge. Aplurality of pushers is disposed within the cartridge and is operativelyassociated with the plurality of retention slots where the plurality ofpushers is adapted to support the plurality of fasteners. A drive memberis movable through the cartridge and is adapted to engage the pluralityof pushers to urge the plurality of fasteners through the plurality ofretention slots. The elongate member may be made from a flexiblematerial.

Each fastener may include a backspan and a pair of legs extending fromthe backspan. The backspan of each fastener may be disposed on a firstside of the elongate member and the pair of legs of each fastener mayextend through the elongate member to a second side of the elongatemember.

The surgical stapling apparatus may further include an anvil assemblyincluding an anvil plate for receiving and forming a fastener. The anvilassembly is in juxtaposed relation to the cartridge and at least one ofthe anvil assembly and the cartridge is movable in relation to the otherof the anvil assembly and the cartridge.

The drive member includes an actuating member extending proximallytherefrom which is adapted to move the drive member through theplurality of openings of the cartridge upon actuation of the actuationmechanism.

The elongate member may be adapted to translate through at least aportion of the elongated body.

A method of using a reloadable surgical stapling apparatus during asurgical procedure is disclosed including inserting the surgicalstapling apparatus into a surgical site, grasping a first portion oftissue between an anvil assembly and a cartridge assembly of thesurgical stapling apparatus, actuating an actuator assembly of thesurgical stapling apparatus to drive a first group of fasteners throughretention slots of the cartridge assembly and into the first portion oftissue to secure the first group of fasteners to the first portion oftissue, actuating the actuator assembly to release the first portion oftissue and to position a second group of fasteners within the cartridgeassembly in substantial alignment with the retention slots, grasping asecond portion of tissue between the anvil assembly and cartridgeassembly, and actuating the actuator assembly to drive the second groupof fasteners through the retention slots and into the second portion oftissue to secure the second group of fasteners to the second portion oftissue.

The method may further include releasing the second portion of tissueand removing the surgical stapling apparatus from the surgical sitewhere the surgical stapling apparatus is removed from the surgical siteafter at least the first and second groups of fasteners have beensecured to the first and second portions of tissue respectively.

Driving one of the first and second groups of fasteners through theretention slots may include translating a drive member at leastpartially through the cartridge assembly to engage a plurality ofpushers disposed in the cartridge assembly and substantially alignedwith the retention slots to drive the plurality of pushers towards theretention slots. Driving the plurality of pushers towards the retentionslots may include engaging guide surfaces of the plurality of pusherswith one of the first and second groups of fasteners to urge thefasteners through the retention slots.

The cartridge assembly may include an elongate member extendingtherethrough and having the first and second groups of fastenersextending therethrough and arranged in a plurality of longitudinallyextending rows. Actuating the actuator assembly to position the secondgroup of fasteners within the cartridge may include translating theelongate member through the cartridge assembly. Urging one of the firstand second groups of fasteners through the retention slots may includeurging backspans of the fasteners through the elongate member.Translating the elongate member through the cartridge assembly mayinclude translating an empty portion of the elongate member out of thecartridge assembly.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described hereinbelowwith references to the drawings, wherein:

FIG. 1A is a perspective view of a surgical stapling apparatus, withportion in phantom, in accordance with the principles of the presentdisclosure;

FIG. 1B is a perspective view of the distal portion of the surgicalstapling apparatus of FIG. 1A;

FIG. 2A is a perspective view of the housing of the surgical staplingapparatus of FIG. 1 showing the elongate member and fasteners extendingout of the housing;

FIG. 2B is a front perspective view of the housing of FIG. 2A;

FIG. 2C is a side perspective view of the housing of FIG. 2A;

FIG. 2D is a side perspective of FIG. 2C with the lower housing removed;

FIG. 2E is a front perspective view of FIG. 2B. with the elongate memberand fasteners removed;

FIG. 3A is a perspective view of the distal portion of the surgicalstapling apparatus of FIG. 1A;

FIG. 3B is a perspective view of the juncture between the housing andthe cartridge assembly of FIG. 3A;

FIG. 3C is a perspective view of FIG. 3B with the upper housing removed;

FIG. 3D is a perspective view of the cartridge of FIG. 3A;

FIG. 4A is top plan view of the cartridge of FIG. 1A;

FIG. 4B is an end view of FIG. 4A showing the fasteners disposed in thegrooved channels;

FIG. 4C is a bottom plan view of FIG. 4B;

FIG. 4D is a side cross-sectional view of FIG. 4A;

FIG. 4E is a perspective cross-sectional view of FIG. 4D;

FIG. 5A is a front perspective view of the cartridge assembly of FIG. 1Ashowing the drive member translating through the cartridge to drive thefasteners through the retention slots;

FIG. 5B is an end view of FIG. 5A;

FIG. 5C is a perspective view of the drive member, pushers and fastenersof FIG. 5A;

FIG. 5D is a perspective view of the drive member and elongate member ofFIG. 5A;

FIG. 5E is a top plan view of the elongate member of FIG. 5A;

FIG. 5F is a side perspective view, partially in section, of the drivemember and pushers of FIG. 5A;

FIG. 5G is a front perspective view of the pushers of FIG. 5A withfasteners resting in the guide grooves;

FIG. 6A is a perspective view of the pushers and fasteners of FIG. 1Ashowing guide grooves and guide portions on the pushers and fastenersrespectively;

FIG. 6B is an alternate embodiment of the fastener of FIG. 6A;

FIG. 6C is an alternate embodiment of the fastener of FIG. 6A;

FIG. 7A is a front perspective view of the drive member and pusher ofFIG. 1A showing the pusher seated on the peak portion;

FIG. 7B is a front perspective view of FIG. 7A showing the pushers withthe posts engaging the channel of the drive member as the pusherstranslate up the ramp;

FIG. 7C is a rear perspective view of FIG. 7A showing only the drivemember;

FIG. 8 is a top view of the drive member and pusher of FIG. 1A;

FIG. 9 is a side cross-sectional view of the sled and pusher of FIG. 8,taken along section line 9-9, prior to the drive member engaging thepusher;

FIG. 10 is a view of FIG. 9 showing the post of the pusher engaging thechannel of the drive member at the inlet opening;

FIG. 11 is a view of FIG. 10 showing the pusher translating up the rampof the drive member;

FIG. 12 is a view of FIG. 11 showing the pusher at the peak portion ofthe drive member with the fastener having been formed;

FIG. 13 is a view of FIG. 12 showing the pusher after the drive memberhas continued proximally;

FIG. 14 is a view of FIG. 13 showing the drive member returningdistally;

FIG. 15 is a view of FIG. 14 showing the outlet of the channel engagingthe post of the pusher;

FIG. 16 is a view of FIG. 15 showing the post of the pusher engaging thechannel to draw the pusher down the ramp of the drive member;

FIG. 17 is a view of FIG. 16 showing the pusher at the bottom of theramp;

FIG. 18 is a view of FIG. 17 showing the pusher in pre-firing positionwith the drive member continuing to return distally; and

FIG. 19 is a side cross-sectional view of the end effector of thesurgical stapling apparatus of FIG. 1A after the drive member has beentranslated to the fully fired position.

DETAILED DESCRIPTION OF THE EMBODIMENTS

In the drawings and in the description which follows, in which likereferences numerals identify similar or identical elements, the term“proximal” will refer to the end of the apparatus which is closest tothe clinician during use, while the term “distal” will refer to the endwhich is furthest from the clinician, as is traditional and known in theart.

FIG. 1A illustrates a surgical stapling apparatus 10 including anembodiment of an end effector according to the present disclosure showngenerally as end effector 100. As shown in FIG. 1A, and as will bediscussed hereinbelow, end effector 100 is configured for attachment toan actuator assembly 12 to form surgical stapler 10. Actuator assembly12 includes a handle assembly 20 and an elongated body 30 extending fromhandle assembly 20. Elongated body 30 is configured for use in closedprocedures, i.e., laparoscopic, endoscopic, arthroscopic, however,elongated body 30 may be shortened or eliminated for use in openprocedures. In the present disclosure, actuator assembly 12 will only bedescribed to the extent necessary to fully disclose end effector 100.For a more detailed description of the structure and function of asurgical stapler similar to actuator assembly 12, please refer tocommonly owned U.S. Pat. No. 5,865,361 to Milliman et al. (“Milliman'361 patent”), the contents of which is incorporated herein in byreference in its entirety.

Referring to FIGS. 1A and 1B, end effector 100 includes an anvilassembly 110, a housing 200, a cartridge assembly 300, an elongatemember 400, and a drive member 500. Anvil assembly 110 includes fastenerdeforming depressions 112 (FIG. 19) for deforming fasteners to securetissue “T”.

As seen in FIGS. 2A-2E, housing 200 defines an elongate shape andincludes an upper housing 202 and a lower housing 204 which define a gapor lumen 206 therebetween extending longitudinally through housing 200.Housing 200 also includes a plurality of passageways 208 extending fromlumen 206 into upper housing 202 and extending longitudinally throughupper housing 202. Lower housing 204 defines longitudinally extendinggrooves 210 extending from lumen 206 into lower housing 204 andlaterally aligned with passageways 208. Housing 200 may also include anactuation channel 212 for receiving an actuation mechanism 502 (FIG. 5A)therethrough. Actuation mechanism 502 may be used for actuating drivemember 500. Actuation channel 212 may, for example, be disposed in thelower housing 204.

Referring now to FIGS. 3A-3D, cartridge assembly 300 extends fromhousing 200 and includes a casing 302 dimensioned and configured toreceive a cartridge 304. Cartridge 304 includes a plurality of spacedapart channels 306 extending longitudinally therethrough. Cartridge 304also includes a plurality of retention slots 308 extending through anupper surface 310 of cartridge 304 and aligned with the plurality offastener deforming depressions 112 of the anvil assembly 110 (FIG. 19).Plurality of retention slots 308 may define a plurality of rows and eachrow may be associated with one of the plurality of spaced apart channels306. For example, each channel 306 may include an outer row of retentionslots 308A and an inner row of retention slots 308B. A knife slot 318may be disposed between adjacent channels 306 for receiving a knifeblade (not shown) therethrough. Each channel 306 may also includeadditional rows of retention slots 308 as desired, where, for example,each channel 306 may include three or more rows of retention slots 308or each channel 306 may include only a single row of retention slots308.

Cartridge 304 also includes a plurality of grooved channels 312extending longitudinally along an underside 314 of the upper surface 310of cartridge 304. Plurality of grooved channels 312 are each laterallyaligned with one of the rows of retention slots 308. As seen in FIGS.4A-4E, retention slots 308 may also include guide surfaces 316 onunderside 314 of upper surface 310. Guide surfaces 316 may, for example,be chamfered, angled, radial, or other types of contoured surfacessuitable to guiding fasteners through retention slots 308. Cartridge 304also includes a plurality of pushers 350 operatively associated withretention slots 308, as will be described in more detail below.

Referring now to FIGS. 2A-2D, 3B-3C, 5A, 5D, and 5E, elongate member 400includes a plurality of fasteners 600 extending therethrough andarranged in a plurality of longitudinally extending rows 402. Each ofrows 402 may correspond to and align with one of the rows of retentionslots 308 and additional elongate members 400 may be included where, forexample, each channel 306 of cartridge 304 receives an elongate member400. Each fastener 600 includes a pair of legs 602 and a backspan 604(FIGS. 4D-4E) where each backspan 604 is disposed on a first side ofelongate member 400 and each pair of legs 602 extend through elongatemember 400 to a second side. Elongate member 400 and fasteners 600 arelongitudinally translatable through housing 200 where lumen 206 ofhousing 200 is adapted to receive elongate member 400 and passageways208 and grooves 212 are adapted to receive legs 602 and backspan 604 offasteners 600 respectively (FIGS. 2B and 2C). Passageways 208 andgrooves 212 are adapted to guide fasteners 600 through housing 200 aselongate member 400 translates longitudinally through housing 200.Elongate member 400 and fasteners 600 are also longitudinallytranslatable through the housing and cartridge assembly 300 to move thefasteners from a position proximal of the retention slots to a positionin line with the slots. Channels 306 are adapted to receive elongatemember 400 and fasteners 600, while grooved channels 312 engage at leasta portion of legs 602 of fasteners 600 to maintain the lateral positionof fasteners 600 relative to retention slots 308 (FIGS. 3B, 3C, and 4B).Elongate member 400 may be made of a flexible or deformable materialsuch as, for example, a rubber, a cotton or other cloth, fabric, ortextile, a plastic web or mesh, a plastic compound, silicone, gumrubber, or any other material suitably flexible and adaptable fortranslation through housing 200 and cartridge assembly 300 to allowfasteners 600 to be fired by pushers 350. Elongate member 400 includesopenings 404 therethrough for the reception of fasteners 600. Eachopening 404 may include, for example, a pair of holes 406 and 408 and aslit 410 extending at least partially therebetween, as seen in FIG. 5E.Each pair of legs 602 of fasteners 600 extends through pair of holes 406and 408 respectively and each backspan 604 is substantially aligned withone of slits 410.

Referring now to FIGS. 5F-5G, 6A-6C, and 7A-7C, pushers 350 include aplurality of pushing surfaces 352 for engaging fasteners 600 and pushingsurfaces 352 may define guide grooves 354 for engaging backspans 604 andguide portions 606 of fasteners 600. Guide portions 606 may be definedby backspans 604 or may be in addition to backspans 604 (FIGS. 6A-6C).Guide grooves 354 are configured to maintain the alignment of fasteners600 relative to retention slots 308 and to assist in guiding andstabilizing fasteners 600 as they move through retention slots 308.Guide grooves 354 may, for example, include sloped surfaces 356 and 358(FIG. 6A) for centering backspans 604 of fasteners 600 within guidegrooves 354 and may define a shape corresponding to guide portions 606for receiving and engaging guide portions 606 and backspans 604. Slopedsurfaces 356 and 358 may, for example, be any angled, radial, orcontoured surface suitable to provide lateral support to fasteners 600and assist in positioning or centering fasteners 600 during firing.Pushers 350 also include flanged portions 360 for engaging alignmentslots 320 of cartridge assembly 300 and guiding pushers 350 towardretention slots 308. Pushers 350 may also include posts or protrusions362 (FIG. 5G) for engaging drive member 500.

Referring now to FIGS. 1B, 5A, 5C, 5D, 5F, 7A-7C, and 8-19, drive member500 is longitudinally translatable through cartridge assembly 300 (FIG.5A) between an initial position at a distal portion of cartridgeassembly 300 (FIG. 1B) and a fully fired position at a proximal portionof the cartridge assembly 300 (FIG. 19). It is also contemplated thatthe initial position may be at a proximal portion of cartridge assembly300 and the fully fired position may be at a distal portion of cartridgeassembly 300 where drive member 500 translates distally from the initialposition to the fully fired position. Drive member 500 may optionally beonly partially translated through cartridge assembly 300 such that onlya portion of fasteners 600 is fired.

Drive member 500 is operatively associated with plurality of pushers 350such that as drive member 500 translates through cartridge assembly 300,drive member 500 engages each of pushers 350 with ramps 504 (FIGS.9-12). Pushers 350 translate along ramps 504 to urge fasteners 600through retention slots 308. Pushers 350 may also include distal slopedsurfaces 364 for engaging ramps 504 during translation of drive member500 from the initial position toward the fully fired position (FIGS.10-12).

Drive member 500 may include slots 506 for receiving posts 362 ofpushers 350 and posts 362 may be substantially cylindrical or curved tofacilitate entry into slots 506. Alternatively posts 362 maybe any shapesuitable for entry into slots 506 to provide a camming action with slots506 including, for example, linear shapes, squares, triangles, oblongshapes, or other polygonal or curved shapes. Slots 506 each define aninlet opening 508 at a leading or proximal portion 510 of drive member500, a channel 512 extending substantially parallel to ramp 504 fortranslation of posts 362 therethrough, and an outlet opening 514 at atrailing or distal portion 516 of drive member 500, as seen in FIGS.9-18. Trailing portion 516 may also include ramps 518 and outletopenings 514 may be defined at a peak portion 522 of drive member 500 ormay be defined at the trailing edge 520 of ramps 518. Pushers 350 mayinclude proximal sloped surfaces (not shown) for engaging ramp 518during translation of drive member 500 from the fully fired position(FIG. 19) toward the initial position (FIG. 1B). Channel 512 may furtherinclude a distal portion 526 (FIG. 5F) extending through drive member500 parallel to ramp 518 for receiving posts 362. In alternativeembodiments, no posts 362 or slots 506 are included for use with pushers350 where, for example, pushers 350 engage ramps 504 without the supportof posts 362 and slots 506.

Referring now to FIGS. 2D, 5A, 5F, and 7A-7C, drive member 500translates through cartridge assembly 300 by actuation of actuationmechanism 502 (FIG. 5A). Actuation mechanism 502 is operativelyassociated with actuator assembly 12 and is coupled to drive member 500.Actuation mechanism 502 extends from actuator assembly 12 throughactuation channel 212 of housing 200, cartridge assembly 300, and alumen 524 of drive member 500. Lumen 524 extends through drive member500 and is adapted for the reception of actuation mechanism 502. Lumen524 may, for example, include an internal thread for engaging actuationmechanism 502. Actuation mechanism 502 may be in the form of a screw, arod or other mechanism suitable to translate drive member 500 throughcartridge assembly 300.

Actuator assembly 12 may be adapted to independently translate elongatemember 400 through housing 200 and cartridge assembly 300 through theuse of an actuator (not shown) such as, for example, a spool, a gearsystem or another suitable mechanism for advancing elongate member 400through housing 200 and cartridge assembly 300. The actuator maydirectly contact elongate member 400 or may instead drive a pulleysystem to translate elongate member 400 through housing 200 andcartridge assembly 300. Elongate member 400 may be wound around a pulleyor other suitable mechanism at the distal end of end effector 100 andmay return to housing 200 via cartridge 300. For example, elongatemember 400 may return through channels 306 of cartridge 300 to lumen 206of housing 200. Alternatively a separate pathway 322 (FIG. 19) may bedefined by both cartridge 300 and housing 200 for receiving the usedportion of elongate member 400.

Elongate member 400 may, for example, include a feed mechanism 412 (FIG.5E) such as a slot or cut-out which is engagable by a gear or spoolmechanism to advance elongate member 400 through housing 200 andcartridge assembly 300. The actuator may also be configured to cooperatewith drive member 500 after firing to return drive member 500 to theinitial position at the distal end of end effector 100 while re-loadingcartridge 300 with a new set of fasteners 600. Alternatively, drivemember 500 may include hooked portions (not shown) for engaging feedmechanism 412 as drive member 500 returns to the initial position afterfiring where, for example, the hooked portions are angled at leastpartially in the distal direction such that as drive member 500translates proximally feed mechanism 412 is not engaged with the hookedportions but when drive member 500 translates distally the hookedportions engage feed mechanism 412 and translate elongate member 400distally by the same amount as drive member 500. This allows cartridgeassembly 300 to be reloaded through the single action of resetting ortranslating drive member 500 to the initial position and in additionallows a surgeon to at least partially reload cartridge assembly 300during use. For example, if only a portion of the fasteners withincartridge assembly 300 were fired the surgeon may reset drive member 500to the initial position to fully reload the cartridge assembly 300 bythe number of fasteners which were already fired without disposing ofthe remaining fasteners. In addition the surgeon may, for example,perform a partial reloading of the cartridge assembly 300 by translatingdrive member 500 only a part of the way to the initial position afterfiring. This allows the surgeon to utilize variable reloading as neededduring a surgical procedure without having to dispose of or replace thecartridge assembly

Housing 200 may include a pre-determined number of fasteners 600 forfeeding into cartridge assembly 300 where, for example, a number ofreloads or groups of fasteners 600 may be provided to allow a surgeon toreload and fire surgical stapling apparatus 10 multiple times withoutremoving cartridge assembly 300 from the operating site. Each group offasteners 600 may correspond to the number of retention slots 308 or maycorrespond to only a part or portion of the number of retention slots308 where for example multiple groups of fasteners 600 may be requiredto fully reload cartridge assembly 300.

Housing 200 may optionally receive elongate member 400 and fasteners 600from an exterior source where, for example, multiple elongate members400 may be attached or secured together during a procedure to provideadditional fasteners 600 to cartridge assembly 300. For example,elongate body 30 may be adapted to provide elongate member 400 andfasteners 600 to housing 200 and may be adapted to allow a surgeon tofeed additional elongate members 400 and fasteners into housing 200. Inthis way the number of fasteners 600 to be used may be tailored to aspecific procedure or need of the surgeon.

During use, surgical stapling apparatus 10 is inserted into the surgicalsite and maneuvered such that tissue “T” is positioned between anvilassembly 110 and cartridge assembly 300. Handle assembly 20 is thenactuated to close or approximate anvil assembly 110 and cartridgeassembly 300 to grasp tissue “T” therebetween. After tissue “T” isgrasped between anvil assembly 110 and cartridge assembly 300 actuatorassembly 12 is actuated to translate drive member 500 proximally throughcartridge assembly 300 from the initial position (FIG. 1A) to the fullyfired position (FIG. 19) to fire a first group of fasteners 600. Thesurgical stapling apparatus 10 may come with the first group offasteners 600 initially disposed within cartridge 300 and ready forfiring or the first group of fasteners 600 may be translated intocartridge assembly 300 prior to firing. As discussed above, drive member500 may optionally be translated only partially through cartridgeassembly 300 to fire only a portion of the first group of fasteners 600disposed within cartridge assembly 300. As drive member 500 translatesthrough cartridge assembly 300, posts 362 of pushers 350 are engagedwith inlet opening 508 and enter channel 512 (FIGS. 9 and 10). At thesame time distal sloped surfaces 364 of pushers 350 engage ramps 504 ofdrive member 500 and translate or slide along ramps 504 to urge elongatemember 400 and fasteners 600 toward retention slots 308 (FIGS. 11 and12). As discussed above, fasteners 600 may engage guide surfaces 316 ofretention slots 308 (FIGS. 4C-4E) to assist in guiding fasteners 600through retention slots 308. Guide grooves 354 of pushers 350 engagebackspans 604 and guide portions 606 of fasteners 600 to urge fasteners600 through retention slots 308 (FIGS. 5G, 6A-6C, 12 and 19). As pushers350 urge fasteners 600 through retention slots 308 fasteners 600 breakthrough openings 404 of elongate member 400 where, for example,backspans 604 pass through slits 410 of openings 404. The elongatemember may be adapted to allow the fasteners to break through theelongate member. Openings 404 may be torn or sheared to permit passageof fasteners 600 therethrough. A portion of each of pushers 350 may alsopass through respective openings 404 of elongate member 400 duringfiring. Once fasteners 600 are urged through retention slots 308, legs602 are deformed by the fastener deforming depressions 112 of anvilassembly 110 to thereby staple or fasten the tissue “T” clamped betweenanvil assembly 110 and cartridge assembly 300 (FIGS. 12, 13, and 19).

As drive member 500 translates proximally toward the fully firedposition each fastener 600 is urged through a respective retention slot308. After drive member 500 moves proximally past each of pushers 350the fired pushers 350 remain in the fired position (FIGS. 13 and 19).Alternatively the fired pushers 350 may return at least partially towardthe initial unfired position by sliding along ramps 518 on trailingportion 516 of drive member 500 after exiting distal portion 526 ofchannel 512.

Once firing is complete, actuator assembly 12 is actuated to translatedrive member 500 back to its initial position. During translation ofdrive member 500 back to its initial position drive member 500 engagespushers 350 to return pushers 350 to the unfired position. For example,as seen in FIGS. 14-18, during distal movement of drive member 500,posts 362 of pushers 350 enter outlet opening 514 of channel 512 andengage channel 512 to draw pushers 350 down ramps 504. Posts 362 exitinlet opening 508 at the bottom of ramps 504 to return pushers 350 tothe initial position. Pushers 350 are now ready to receive a new set offasteners 600 from elongate member 400. Alternatively, pushers 350 mayengage ramp 518 to slide towards peak portion 522 prior to posts 362engaging channel 512 if pushers 350 did not remain in the firedposition.

Elongate member 400 is then translated through housing 200 and cartridgeassembly 300 by actuator assembly 12 to provide a second group offasteners 600 to pushers 350 and retention slots 308. During thisprocess, the empty openings 404 of elongate member 400 are translateddistally past drive member 500 before returning to housing 200 viachannels 306 or passageway 322 of cartridge assembly 300. For example,some or all of a second group of fasteners 600 may be translated intocartridge assembly 300 to partially or fully reload cartridge assembly300. When elongate member 400 is positioned within cartridge assembly300 such that a new set of fasteners 600 are aligned with retentionslots 308 and the new set of fasteners 600 are supported on pushers 314,surgical stapling apparatus 10 is ready to be fired. It is contemplatedthat elongate member 400 may be translated through housing 200 andcartridge 300 to reload cartridge 300 before, during or after thetranslation of drive member 500 distally to the initial position.

The surgeon may then open or un-approximate anvil assembly 110 andcartridge assembly 300 to release the fastened tissue “T”.Alternatively, the surgeon may reload cartridge assembly 300 during therelease of tissue “T” or after releasing tissue “T”. The surgeon may nowmaneuver surgical stapling apparatus 10 within the surgical site toposition another portion of tissue “T” or another body tissue betweenanvil assembly 110 and cartridge assembly 300 as desired for further useof surgical stapling apparatus 10 without withdrawing surgical staplingapparatus 10 from the surgical site. For example, the surgeon may graspa new portion of tissue between anvil assembly 110 and cartridgeassembly 300, fire surgical stapling apparatus 10, and reload cartridgeassembly 300 as describe above as many times as desired or necessary forthe surgical procedure without removing surgical stapling apparatus 10from the surgical site. This reduces the length of the surgicalprocedure, reducing the risk involved, and allows the surgeon toconcentrate on the surgical procedure without dividing his attentionbetween performing the procedure and reloading or replacing the surgicalstapling apparatus 10 for further fastening of tissue.

Although the illustrative embodiments of the present disclosure havebeen described herein with reference to the accompanying drawings, theabove description, disclosure, and figures should not be construed aslimiting, but merely as exemplifications of particular embodiments. Itis to be understood, therefore, that the disclosure is not limited tothose precise embodiments, and that various other changes andmodifications may be effected therein by one skilled in the art withoutdeparting from the scope or spirit of the disclosure.

What is claimed is:
 1. An end effector for a surgical staplingapparatus, comprising: a housing defining a plurality of passageways anda lumen extending longitudinally therethrough; a cartridge extendingfrom the housing and including a channel extending longitudinallytherethrough, the cartridge having an upper surface with a plurality ofretention slots extending therethrough for the reception of respectivesurgical fasteners of a plurality of surgical fasteners, the pluralityof surgical fasteners arranged in a plurality of longitudinallyextending rows, each fastener of the plurality of fasteners includes apair of legs, a backspan, and a guide portion disposed adjacent thebackspan and interposed between the pair of legs; a flexible elongatemember having a plurality of openings defined therethrough, the elongatemember releasably retaining the plurality of fasteners therein, theelongate member longitudinally translatable through the housing and thecartridge to move the plurality of surgical fasteners into alignmentwith the plurality of retention slots; a plurality of pushers disposedwithin the cartridge and operatively associated with the plurality ofretention slots, the plurality of pushers adapted to support theplurality of surgical fasteners, each pusher of the plurality of pushersincludes a guide groove; a drive member movable through the cartridgefrom an initial position and adapted to engage the plurality of pushersto urge the plurality of pushers towards the upper surface of thecartridge such that the guide grooves of the plurality of pushers engagethe backspans and guide portions of the respective plurality of surgicalfasteners to guide the plurality of fasteners and urge the plurality ofsurgical fasteners through the plurality of retention slots, theplurality of fasteners being released from the elongate member bytearing of the elongate member at each respective opening of theplurality of openings; and an actuation mechanism for moving the drivemember from the initial position, wherein the elongate member isconfigured to translate distally past the drive member and return to thehousing through the channel of the cartridge.
 2. The end effector ofclaim 1, wherein the elongate member is movable longitudinally.
 3. Theend effector of claim 2, wherein the plurality of surgical fastenersincludes a first group of surgical fasteners and a second group ofsurgical fasteners.
 4. The end effector of claim 2, wherein the drivemember is movable from an initial position to a fully fired position. 5.The end effector of claim 4, wherein the first group of surgicalfasteners is urged through the retention slots when the drive member ismoved to the fully fired position.
 6. The end effector of claim 4,wherein the elongate member is longitudinally movable to move the secondgroup of surgical fasteners into alignment with the plurality ofretention slots.
 7. The end effector of claim 6, wherein each retentionslot of the plurality of retention slots extends in an upward direction.8. The end effector of claim 1, wherein each pusher of the plurality ofpushers has a post and the drive member has a slot with open ends. 9.The end effector of claim 8, wherein movement of the drive member to theinitial position urges the plurality of pushers downwardly.
 10. The endeffector of claim 1, further comprising an anvil assembly with fastenerforming depressions aligned with respective retention slots of theplurality of retention slots.
 11. The end effector of claim 10, whereinthe cartridge and the anvil assembly are movable relative to one anotherto engage tissue therebetween.
 12. The end effector of claim 1, furthercomprising a handle assembly.
 13. The end effector of claim 12, furthercomprising an elongate body for use in endoscopic procedures, theelongate body being engageable with each of the handle assembly and theend effector.
 14. The end effector of claim 1, wherein each opening ofthe plurality of openings defines a pair of holes and a slit interposedbetween the pair of holes.
 15. The end effector of claim 14, whereineach opening of the plurality of openings is configured to retain arespective surgical fastener of the plurality of surgical fasteners. 16.The end effector of claim 15, wherein each surgical fastener of theplurality of surgical fasteners has two legs.
 17. The end effector ofclaim 16, wherein each hole of the pair of holes is configured toreceive a respective leg of the plurality of surgical fasteners.
 18. Theend effector of claim 1, wherein the elongate member is configured totranslate through the housing and the cartridge to partially re-load thecartridge with a second plurality of surgical fasteners.
 19. The endeffector of claim 18, wherein the elongate member is configured totranslate through the housing and the cartridge such that the secondplurality of surgical fasteners, having fewer surgical fasteners thanthe plurality of retention slots, is aligned with a corresponding numberof retention slots of the plurality of retention slots.
 20. The endeffector of claim 1, further comprising a pulley rotatably supported ona distal portion of the end effector, the pulley configured to engagethe elongate member and enable the elongate member to translate distallypast the drive member and return to the housing through the channel ofthe cartridge.